Not war, not terrorism, the impact of hybrid warfare on emergency medicine

Background: Russia’s annexation of Crimea in 2014, and the recent Russo-Ukrainian war that started in 2022, were triggers that radically changed the perception of security in the Nordic and Baltic countries. The on-going Russian hybrid war has resulted in a renewed global interest in the safety and security of many countries (eg, the Nordic-Baltic Eight). The prospective North Atlantic Treaty Organization (NATO) membership of Finland and Sweden may drastically change the regional military and political landscape. The objective of this study was to identify and characterize all documented terrorist attacks in this region as reported to the Global Terrorism Database (GTD) from 1970 through 2020. Methods: The GTD was searched using the internal database functions for all terrorism incidents in the Nordic-Baltic states: Denmark, Estonia, Finland, Iceland, Latvia, Lithuania, Norway, and Sweden. Temporal factors, location, target type, attack and weapon type, perpetrator type, number of casualties, and property value loss were collated. Results were exported into an Excel spreadsheet for analysis. Results: There were 298 terrorism-related incidents from 1970 through 2020. Most attacks occurred in Sweden, followed by Norway and Finland. No entries were recorded for the Baltic states prior to their independency in 1991. The 298 incidents resulted in a total of 113 fatalities and 277 injuries. Facility/infrastructure attacks were the most frequently identified attack type (35.0%), followed by bombings and explosions (30.9%). Armed assaults were responsible for 80 fatalities and 105 injuries, followed by bombings/explosions with 15 fatalities and 72 injuries. The predominant target types were immigrants and refugee shelters (64/298 incidents). In only 33.6% of the incidents, perpetrators were known. Right-wing assailants represented the largest group, accounting for 27 incidents. Conclusion: From 1970 through 2020, there were 298 terrorist attacks in the Nordic-Baltic Eight. Sweden accounted for 50% of incidents. The profile of terrorist attacks was very diverse, as were the perpetrators and targets. Every country had its own incident characteristics. The surge of right-wing extremism must be closely monitored.

show abstract

“…Counter-Terrorism Medicine will gain influence and importance, as the threats show a steady uptrend. [34][35][36][37]…”

Section: Discussionmentioning

confidence: 99%

An Epidemiological Analysis of Terrorist Attacks in the Nordic and Baltic Countries from 1970 through 2020

Cauwer

Granholm

Khorram‐Manesh

et al. 2023

Prehosp. Disaster med.

Self Cite

View full text Add to dashboard Cite

show abstract

“…While kinetic attacks such as the 2022 targeting of land and subsea cables in and around France remain a serious threat, 42 the utilization of cyberattacks by violent non-state-based organizations has taken on a distinct similarity to hybrid-warfare. 43 While there is currently debate on whether ideologically motivated cybercrime rises to the level of cyberterrorism, the United States Department of Homeland Security (Washington, DC USA) has predicted the use of cyberattacks as a likely methodology of terrorist activity. 44 Taubman © 2023 Prehospital and Disaster Medicine Health care is particularly vulnerable to cyberattacks and is one of the most frequently targeted and costly entities, with an average total cost of US$10.1 million per breach in the United States.…”

Section: Discussionmentioning

confidence: 99%

Reviewing the Health Care Impacts of Attacks on Critical Infrastructure

Taubman,

Hart,

Hertelendy

et al. 2023

Prehosp. Disaster med.

Self Cite

View full text Add to dashboard Cite

Introduction: Health care provision depends on reliable critical infrastructure (CI) to power equipment and to provide water for medication and sanitation. Attacks on CI limiting such functions can have a profound and prolonged influence on delivery of care. Methods: A retrospective analysis of the Global Terrorism Database (GTD) was performed of all attacks occurring from 1970-2020. Data were filtered using the internal database search function for all events where the primary target was “Utilities,” “Food or Water Supply,” and “Telecommunications.” For the purposes of this study, the subtype “Food Supply” was excluded. Events were collated based on year, country, region, and numbers killed and wounded. Results: The GTD listed 7,813 attacks on CI, with 6,280 of those attacks targeting utilities, leading to 1,917 persons directly killed and 1,377 persons wounded. In total, there were 1,265 attacks targeting telecommunications causing 205 direct deaths and 510 wounded. Lastly, 268 attacks targeted the water supply with 318 directly killed and 261 wounded. Regionally, South America had the most attacks with 2,236, followed by Central America and the Caribbean with 1,390. Based on infrastructure type, the most attacks on utilities occurred in El Salvador (1,061), and the most attacks on telecommunications were in India (140). Peru (46) had the most attacks on its water supply. Conclusion: The regions with the highest number of total attacks targeting CI have historically been in South America, with more attacks against power and utilities than other infrastructure. Although the numbers of persons directly killed and wounded in these attacks were lower than with other target types, the true impacts on lack of health care delivery are not accounted for in these numbers. By understanding the pattern and scope of these attacks, Counter-Terrorism Medicine (CTM) initiatives can be created to target-harden health care-related infrastructure.

show abstract

“…Hybrid warfare, a topic much discussed under the Counter-Terrorism Medicine (CTM) framework, is often described as a mix of conventional warfare, irregular warfare, terrorism, criminality, and different types of other hybrid threats such as CBRN and cyberattacks. 12 , 13 Traditionally, the use of CBRN weapons has been seen as an irrational high-risk act for VNSAs and state players. However, in the past few decades, the use of CBRN weapons in targeting civilian settings and to assassinate political targets indicates a dangerous erosion in the honor of international conventions.…”

Section: Discussionmentioning

confidence: 99%

A Descriptive Analysis of the Use of Chemical, Biological, Radiological, and Nuclear Weapons by Violent Non-State Actors and the Modern-Day Environment of Threat

Tin

Cheng

Shin

et al. 2023

Prehosp. Disaster med.

Self Cite

View full text Add to dashboard Cite

Introduction: The use of chemical, biological, radiation, and nuclear (CBRN) weapons is not new, and though rare, it is an issue of concern around the world due to their ability to cause large-scale mass-casualty events and their potential threat to global stability. The purpose of this study is to explore the use of CBRN weapons by non-state actors through analysis of the Violent Non-State Actor (VNSA) CBRN Event database, and aims to better inform health care systems of the potential risks and consequences of such events. Methods: Data collection was performed using a retrospective database search through the VNSA CBRN Event database. Results: A total of 565 events were recorded. Five hundred and five (505) events (89.4%) involved single agents while 60 events (10.6%) involved multiple agents. Fatalities numbered 965 for chemical agents, 19 for biological agents, and none for radiological and nuclear events. Injuries numbered 7,540 for chemical agents, 59 for biological agents, 50 for radiological events, and none for nuclear attacks. Fatality and injury per attack was 2.22 and 17.37, respectively, for chemical event agents and 0.15 and 0.48, respectively, for biological event agents. Conclusion: Violent Non-State Actors were responsible for 565 unique events around the world involving the use of CBRN weapons from 1990-2020. The United States (118), Russia (49), and Iraq (43) accounted for the top three countries where these events occurred. While CBRN events remain relatively rare, technological advances have the potential to facilitate the use of such weapons as part of a hybrid warfare strategy with significant repercussions for civilian health and health care systems.

show abstract

Not war, not terrorism, the impact of hybrid warfare on emergency medicine

Cited by 10 publications

References 16 publications

An Epidemiological Analysis of Terrorist Attacks in the Nordic and Baltic Countries from 1970 through 2020

An Epidemiological Analysis of Terrorist Attacks in the Nordic and Baltic Countries from 1970 through 2020

Reviewing the Health Care Impacts of Attacks on Critical Infrastructure

A Descriptive Analysis of the Use of Chemical, Biological, Radiological, and Nuclear Weapons by Violent Non-State Actors and the Modern-Day Environment of Threat

Contact Info

Product

Resources

About